GOOD SAMARITAN HOSPITAL-LOS ANGELES
1225 WILSHIRE BOULEVARD
LOS ANGELES, CA 90017
http://www.goodsam.com
Contact:
Rewa Cooper
(562) 698-0811 Ext. 12310
License:
General Acute Care Hospital
Total Beds: 408
Emergency Room: Yes
OSHPD ID:
106190392
Fair Pricing Policy Information
Policy Effective Date:11/1/2014
Download:
Federal Poverty Level for Free Care:
200%
Discount Payment Effective Date:11/1/2014
Discount Payments:
Discount Payment 1
FPL Range: 201%-350%
Payment Basis:
Other: Partial charity care discount on services
Discount Payment 2
FPL Range: 0%-0%
Payment Basis:
Discount Payment 3
FPL Range: 0%-0%
Payment Basis:
Other Discount Payment Information:
Self Pay Patients whose family income is less than 200% of the FPL will be eligible for a full, 100% charity care discount on services rendered. Self Pay Patients whose family income is between 200% and 350% of the FPL will be eligible for a partial charity care discount on services rendered equal to 60% of applicable cash price — see Cash Price Policy. A High Medical Cost Insured Patient is eligible for a 100% Discount on outstanding patient liability amounts if his or her family income is at or below 350% of the FPL, and his or her out-of-pocket medical expenses in the prior twelve (12) months (whether incurred in or out of any hospital) has exceeded 10% of his or her family income
Application Form Information
Application Form Eff Date:12/13/2014
Download:
Income Type Used:
Salary Received
Language Information
Available Languages:
English
Spanish
Korean
Additional Information
The attached policy,which was originally written in 1999, was revised in August 2006 to comply with AB 774, effective 1/1/2007. It was again reviewed/revised in August 2007 and Board approved on 9/27/2007. Last revised on 11/14 and last approved by the board in November 2017,.
Source” : https://syfphr.oshpd.ca.gov/SearchDetail.aspx?oshpdid=106190392